'Should Babies in Measles Outbreak Areas Get an Extra MMR Shot?'

 Support is building among pediatric infectious disease experts to recommend an extra dose of the measles, mumps, and rubella (MMR) vaccine for infants ages 6 to 11 months who live in or travel to areas of the U.S. with measles outbreaks.

Earlier this month, former CDC director Rochelle Walensky, MD, and colleagues advocated in JAMAopens in a new tab or window and in STATopens in a new tab or window for expanding current vaccine recommendations to include this group.

While current guidelinesopens in a new tab or window from the Advisory Committee on Immunization Practices (ACIP) allow for an early MMR dose for infants in this age group who travel internationally, this would expand that recommendation domestically, they noted.

"With vaccination rates declining, cases rising, and healthcare providers encountering their first cases of a disease once eliminated, we believe it is time to re-evaluate national measles immunization guidelines, particularly to safeguard a vulnerable group still not fully accounted for in vaccination recommendations: our youngest infants," they wrote in the STAT op-ed.

Several experts contacted by MedPage Today agreed with their assertion.

"If infants are going to travel to Lubbock, Texas, or an area where they can be exposed, they definitely should get a dose of MMR vaccine at least 2 weeks before traveling and make sure that family members are up to date on their MMR vaccine also," Tina Tan, MD, a pediatric infectious disease physician at Lurie Children's Hospital of Chicago and current president of the Infectious Disease Society of America, told MedPage Today.

Mary Caserta, MD, a pediatric infectious disease specialist at the University of Rochester Medical Center in New York and a member of the American Academy of Pediatrics (AAP) Committee on Infectious Diseases, said the COVID-19 pandemic "taught people that science and medicine changes with time as we gain more data and information."

"So, if we have data showing that there's an increased risk of measles in the United States, I'm definitely in favor of reviewing our immunization guidelines to see what we can do to best protect our children," Caserta told MedPage Today.

Indeed, the AAP's Red Book statesopens in a new tab or window that "during a community-wide outbreak that affects infants, MMR vaccine has been shown to be efficacious and may be recommended for infants 6 through 11 months of age."

ACIP currently recommends that kids get their first MMR shot at age 12 months, and the second dose between ages 4 and 6, usually before starting kindergarten.

In their op-ed, Walensky and colleagues explained that infants usually receive some protection from antibodies passed on from their mothers during pregnancy, but that this protection usually fades after 6 months. That leaves a "vulnerable gap between then and the first vaccine dose at 12 months," they wrote.

That gap hasn't been a major concern, as the U.S. had eliminated the disease and cases were rare -- until recent years as MMR vaccination levels have slipped while vaccine hesitancy has risen, they noted.

"With measles resurging, we cannot rely on guidelines designed for an era when the virus was eliminated from American communities," they wrote in the STAT piece. "Protecting infants demands policies that reflect today's reality: Measles outbreaks are happening here at home, placing the youngest and most vulnerable at risk."

Overall, there have been 483 measles cases in the U.S. thus far this year, according to the CDCopens in a new tab or window. As of March 28, Texasopens in a new tab or window has reported 400 measles cases in the state's South Plains and Panhandle regions since late January, while New Mexicoopens in a new tab or window has reported 44 cases. In Texas, 41 of the patients have been hospitalized and one deathopens in a new tab or window occurred in a school-aged child who was not vaccinated and had no known underlying conditions.

Tan said the "only way we are going to control these outbreaks is by vaccinating," but cautioned that the "growing issue of vaccine hesitancy, distrust in science, and spread of misinformation is one of the biggest challenges" to keeping children protected.

Advocating for MMR vaccination is a personal matter for Caserta. She contracted measles as a child, before the vaccine was available.

"I was about 5 or 6 years old," she recalled. "To this day, the things I remember most are the conjunctivitis, the cough, and the fever. My eyes were extremely painful. Thankfully, I recovered fully, but I was very ill."

https://www.medpagetoday.com/pediatrics/vaccines/114910